Psychotherapy is often the go-to treatment for PTSD. But what specific types and approaches work best?
The symptoms of post-traumatic stress disorder (PTSD) range from flashbacks to hypervigilance to interpersonal challenges. Symptoms can make it hard for you to function — not to mention bring along a great deal of distress.
But with the right support and treatments, recovery is possible. This is where psychotherapy (aka talk therapy) comes in.
Psychotherapy refers to a range of techniques that can assist you with recognizing — and changing — behaviors, thoughts, and emotions that may be causing you distress.
There are several approaches and techniques within the psychotherapy umbrella. Each is based on certain views of the human mind and experiences, and some of them might work better at treating trauma symptoms.
Trauma-focused therapy falls under this category.
Some experts believe trauma is less about the event that occurred than its impact on your nervous system. Consequently, it may lead you to experience intense symptoms that, if not treated, can be felt long into the future.
Trauma-focused psychotherapy works by identifying how the traumatic circumstances may have affected your mental, physical, and emotional well-being.
The same way we all react differently to traumatic circumstances, we may also have different responses to psychotherapy. What works for one person may not be the same thing that works for you and your symptoms.
However, clinical accounts and research-based evidence seem to point to a few therapy approaches as the most effective when treating trauma.
Eye movement desensitization and reprocessing (EMDR)
According to Carrie Torn, a psychotherapist working in Texas and North Carolina, EMDR “uses eye movements, similar to what occurs during REM sleep, to help facilitate information processing and reduce the effects of trauma and the accompanying negative beliefs.”
“After successful EMDR treatment, you will still remember what happened, yet you will not be overwhelmed when recalling painful memories of the incident,” Torn says.
For more than 30 years, research has shown how effective EMDR therapy can be for PTSD.
Internal family systems (IFS)
IFS is an approach based on the belief that you aren’t separated from your internal “family” — inner parts that need to be integrated for wholeness. This integrative approach may help reduce anxiety and depression, which can occur with PTSD.
IFS for PTSD may focus on those parts of you that continue avoiding memories or cues from the traumatic experience. The approach assumes these parts may be getting in the way of your healing because they can make you feel vulnerable.
It doesn’t mean there’s anything wrong with these parts of you. What it means is that as they fulfill their role, they may interrupt the work your healing parts are trying to achieve.
The goal of IFS is to help you reach an integrated, wholesome sense of self. This would, in turn, help you cope with those aspects of yourself that you might be leaving aside or avoiding because they deal with intense emotions of vulnerability.
Prolonged exposure therapy
Exposure therapy “reconnects” you to the traumatic event you experienced in a gradual and controlled way. This could help you face your fears so your reactivity to them decreases and, in time, you don’t feel the need to avoid triggers or cues.
There are usually 12 to 15 weekly sessions, each of which are about 60–120 minutes long. During these sessions you’ll be gradually exposed to your fears or similar triggers. This exposure could be in person or in your imagination. For example, you could mentally revisit the places you’re avoiding.
Research suggests this approach may be effective in treating chronic or recurring symptoms of PTSD.
Cognitive restructuring is part of cognitive behavioral therapy (CBT). It refers to a group of techniques that aim to help you make sense of the traumatic event and your reactions to it.
Specifically, cognitive restructuring helps you identify thought patterns that aren’t based on facts and that may be adding a filter to your experiences and emotions. These cognitive distortions may be at the heart of some of your symptoms, like anger, anxiety, low mood, or guilt.
Once identified, you can work with your therapist on reframing these thoughts.
In other words, you may not be able to change what happened to you, but you can learn to look at certain situations differently — which can help alleviate some of your distress.
Don McCasland, a certified clinical trauma professional, notes that there are several PTSD symptoms that can be eased with psychotherapy.
“However, in my experience, both professional and personal, the biggest one is the tendency to self-isolate, and to keep stuff bottled inside,” he says.
“If a trauma survivor is fortunate enough to find a therapist that they can connect with, and that they feel is present in the moment for them in a nonjudgmental and accepting way, we can then start to share our story and the things we struggle with on a daily basis,” he explains.
Psychotherapy can help with many PTSD symptoms, like:
Deciding to go with individual or group therapy is a personal decision. You may even try both.
What’s important is that you feel comfortable and supported, and psychotherapy can do this for you in different ways.
Here are some of the potential pros and cons of group therapy versus individual therapy:
Pros of group therapy:
- a sense that you’re not alone in your experiences
- social support
Cons of group therapy:
- discomfort if you’re hesitant to share your story in a group setting
- difficulty attending if your trauma or anxiety is worsened in social settings
Pros of individual therapy:
- more personal and can often be customized to you
- offers you the potential to express emotions more comfortably than in a group setting
Cons of individual therapy:
- can be more expensive than group therapy
- no access to other people’s experiences
- pressure to talk for an entire session, which could feel uncomfortable at first if you have difficulty sharing your thoughts and emotions
Even though what works for you may not look the same for others, evidence suggests that individual therapy can be more effective at treating PTSD. (That doesn’t mean you can’t try both).
Residential — or inpatient — treatment for PTSD can provide you with an intensive supportive environment. This may be especially valuable if you’re facing difficulties at home that might interfere with your recovery, or if you have symptoms of complex post-traumatic stress disorder (C-PTSD).
In some inpatient facilities, besides psychotherapy, you may also have the chance to engage in other techniques, from support groups to yoga, art therapy, and meditation. This could help you focus all your energy on feeling better and healing from trauma.
You may also have access to a multidisciplinary team of psychologists, occupational therapists, and social workers.
You might spend between 30 and 90 days in inpatient care.
Outpatient care may look different from inpatient, and within outpatient care facilities, what they offer may vary.
In some cases, you may have partial hospitalization care. This means that you might spend 4 to 6 hours per day in a specialized clinic, and then return home.
In other cases, you might go about your daily activities and visit a facility a few times a day for specific activities and therapy sessions. You may also be able to bring your loved ones with you for some of these sessions and activities.
Telehealth and online therapy — where you consult a mental health pro or doctor via Zoom, FaceTime, or phone — has boomed in the past years. But is it effective for someone living with PTSD?
Torn believes so, and has conducted online sessions of EMDR successfully.
Research from 2014 also found that online CBT sessions are as effective as in-person sessions. For PTSD symptoms, however, there’s limited research regarding how effective online treatment is.
A 2017 study suggests some people with PTSD may benefit from online sessions as long as they’re part of a more comprehensive therapeutic process. In a few cases, online-only treatment was beneficial.
Possible downsides? Online therapy may not allow your therapist to see the nuances of your body language. This can be helpful during PTSD treatment. But some therapists have adapted their ways of interacting to compensate for this limitation.
In the end, it comes down to what feels best to you.
Besides psychotherapy, PTSD can be treated with medication. Certain meds could help reduce worry and rumination linked to trauma.
Somatic therapy (also known as somatic experiencing) might also be helpful in relieving some of your symptoms. This is an integrative body-focused therapy, which centers on the physical sensations you may be having.
You might also benefit from the following complementary therapies:
- sound therapy
- mind-body medicine
Remember: You’re not alone — 1 in 11 people will be diagnosed with PTSD at some point in their lives.
And with some trial and error, you can find the treatments that work best for you — including one or more types of psychotherapy. Working with a mental health professional to determine your best route of care can help you on your path to healing.
Psychotherapy can help you unravel what happened (and is happening), and potentially restore a sense of trust and safety in the world.
“Once we feel like we can let that genie out of the bottle, so to speak, very often the sky is the limit as far as our healing, and our ability to gain strength from our experiences,” says McCasland.
If you’re ready, these resources may help you take the first step in reaching out for professional support:
- American Psychiatric Association’s Find a Psychiatrist tool
- American Psychological Association’s Find a Psychologist tool
- Asian Mental Health Collective’s therapist directory
- Association of Black Psychologists’ Find a Psychologist tool
- National Alliance on Mental Illness Helplines and Support Tools
- National Institute of Mental Health’s Helpline Directory
- National Queer and Trans Therapists of Color Network
- Inclusive Therapists